Mr. Leo Kearns:

The Senator certainly does not ask easy questions. She is correct that we need to give it time to implement. However, the Vice Chairman mentioned the urgency and this is why we mentioned the critical path. We need to see a critical path plan with key milestones. The issue of workforce is probably the one that we should be most concerned about. We are in a very difficult position. Covid has exacerbated it but the problems existed prior to that. I believe the RHAs will make a big difference. Generally speaking, people feel that at a local level and with their team there is considerable support and that people are working well together.

We are under enormous pressure to recruit and retain staff across the board. We are in a global market. There is a shortage of healthcare workers worldwide. This is one of the big issues for every healthcare service in the world. In the past, we have not taken a really strategic joined-up approach to this; we have been doing it in a very fragmented way.

The advice the group has given on this is that it is very important that, in parallel with the implementation of the RHAs, there needs to be a cross-system, multilayered workforce strategy that deals with this in a number of different ways. At one level it would deal with the issues in a way that would give people the impression that they are valued. The likes of junior doctors, for instance, may have difficulties or working time directive issues, roster issues, issues with emergency tax and so on. There are a lot of what I would call on-the-ground hygiene factors which are really important to the people there. Those issues have to be addressed. The Minister has established a working group, a task force, with relevant people from right across the health service, including non-consultant hospital doctors, NCHDs, to try to address some of those issues in respect of doctors.

There is also the overall planning and the numbers. How many do we need and where do we need them? How many are we bringing through university, nursing schools and recruitment? There is the matter of training places and the number of clinical placements. There is a whole piece of work that needs to be done on planning. There is a very significant project being led by the Department of Health in that regard.

There are also areas like the configuration of services. Can we project forward? If we are to move services into the community, what does that mean for our staffing, and are we training enough people for that? Our challenge is that we are so far off where we should be that it will take time to get us to where we need to be. The thing not to underestimate is the degree to which people who work in healthcare love working in healthcare and do so because they have a vocation. That includes people in the Department. It is not just people on the front line. Generally speaking, people who are interested in healthcare and who want to work in it at policy level or on the front line do so because they really care about it. I think, therefore, that they are absolutely open to responding. They will respond to well thought through, proper strategies that are joined up in order that we do not have one hand working against the other. Unfortunately, this will not be turned around overnight. If, however, there is a sense among staff that this is being taken incredibly seriously and there is a real effort to address it at all those levels, I think we can make progress.